Fetterman's struggles with language highlight the challenges after a stroke – a vascular neurologist explains aphasia and the path to recovery

John Fetterman, the Democratic nominee for a hotly contested U.S. Senate seat in Pennsylvania, has been drawing scrutiny for his performance in his first post-stroke broadcast interview and most recently, his Oct. 25, 2022, Senate debate against Republican Mehmet Oz.

Fetterman suffered a stroke on the way to a campaign event in May 2022. His apparent post-stroke neurological effects - including auditory processing and speech issues – have caused some to question his fitness for the role and have become a central factor in the Senate race. The Conversation asked Andrew Southerland, a vascular neurologist specializing in stroke and cerebrovascular disease who sees many patients like Fetterman, to explain what Fetterman’s case can teach us about stroke recovery.

What does the public know about Fetterman’s stroke?

Fetterman has chosen not to release his full medical record, so it’s not possible to draw conclusions about the exact location or extent of brain injury resulting from his stroke. He and his team have confirmed that his initial symptoms began with feeling fatigued and slurring his speech, which his wife immediately identified as a possible stroke.

Because of her early recognition of his symptoms and rapid transport to a nearby facility, Lancaster General Hospital in Pennsylvania, he had the opportunity to receive a clot-busting drug called a thrombolytic and underwent a catheter-based procedure to remove the blood clot from an artery in the brain.

Based on this information, experts know that Fetterman suffered an ischemic stroke caused by a blockage of blood flow and oxygen to a certain part of the brain. Ischemic stroke accounts for roughly 85% of the 800,000 new cases of stroke occurring each year in the United States. The remainder are hemorrhagic strokes caused by bleeding in or around the brain.

Ischemic stroke often results in a collage of symptoms including facial droop, speech changes and limb weakness, numbness or lack of coordination on one side of the body. These symptoms help bystanders recognize the signs of stroke. When treating ischemic stroke, we in the stroke community use the motto, “Time Is Brain,” because the sooner we can restore blood flow to the brain after a stroke begins the better chance the patient has of making a good recovery.